Greater numbers of infants born with structural or metabolic defects or markedly low birth weight are surviving as a result of recent advances in technology and care. The initial period of life for these infants is spent in intensive care nurseries after which they are discharged in the care of their families. Although these children and their families are the focus of a variety of services, there continues to be unexplained variation in their developmental achievement. The proposed study is to identify predictors of the developmental progress of high risk infants by examining family characteristics and patterns of functioning. Although data regarding the developmental progress of these infants and the impact of having such an infant on the family are available, there is an obvious dearth of data examining the potential impact of the family system functioning on the developmental progress of high risk infants. Specific aims of the study are to: (1) describe parental reactions to the birth of a high risk infant, (2) describe family functioning following the birth of a high risk infant, (3) examine relationships among parental attributions of causality and blame, parental emotional, somatic and functional responses, family system functioning and the developmental progress of high risk infants, and (4) identify family and parental variables which account for the greatest proportion of variance in the developmental progress of high risk infants. A sample of 120 families with high risk infants will be recruited through the neonatal intensive care units of two hospitals in Michigan. Data will be collected at five times based on the infants' age: 3,6,9,12, and 18 months. A subset of the sample, 20 families, will serve as a comparison group to evaluate potential reactivity to the study protocol; they will be assessed at the 3 and 18 months periods. Data collection will take place both in the family home and in developmental assessment clinics. Parental reactions and family characteristics will be obtained in the family home at the 3,9 and 18 months periods. Developmental progress of the infant will be assessed at the 3,6,9,12 and 18 months periods both in the family home and at the developmental clinics. The design will not only allow for identification of important relationships among variables, but also critical points for changes in these relationships. Results will provide essential data necessary to structure nursing interventions with these infants and their families which will promote optimal health and health related outcomes.